March 30, 2005

MEDICINE IS LOVE...:

Useless eaters: disability as genocidal marker in Nazi Germany: The methods used for mass extermination in the Nazi death camps originated and were perfected in earlier use against people with physical, emotional, and intellectual disabilities. This article describes the historical context of attitudes toward people with disabilities in Germany and how this context produced mass murder of people with disabilities prior to and during the early years of-World War II. Several key marker variables, the manipulation of which allowed a highly sophisticated Western society to officially sanction the murder of people with disabilities, are examined. Important implications must continually be drawn from these sad events as we work with people with disabilities at the dawn of a new century. (Mark P. Mostert, Fall, 2002, Journal of Special Education)

Historically, euthanasia has meant a voluntary request for death without suffering by the patient. However, in the 17th century its meaning was modified to grant the right to alleviate suffering exclusively to physicians. While the meaning and implications of euthanasia changed somewhat over time, it was universally accepted that the act of euthanasia was always voluntary. That is, when individuals exercised their right to voluntarily choose the timing and the manner of their death as a means of ending their suffering, it was a physician's responsibility to assist them (Proctor, 1988). However, in the 1890s the meaning of euthanasia in Europe, and especially in Germany, came to include two other aspects. First, the notion of a voluntary "right to die" was extended to mean that in some instances the request for euthanasia could be made by persons other than the suffering patient. Second, the extraordinary levels of care accorded the terminally ill and asylum inmates again raised the issue of negative human worth and underlined the possibility of involuntary euthanasia; that is, the economic burden that terminal illness or caring for the insane placed on families, caregivers, and the community was a factor to consider in decisions for euthanasia. In one sense, therefore, the debate quickly shifted from the idea of a "gentle death" itself to who would request or abet the patient's demise. Subsequent branches of the debate took up the notion of suffering among humans as comparable to that of animals and the implication that in certain instances humans could be disposed of in the same way--quickly and painlessly. The distinction between voluntary euthanasia and involuntary killing was thus effectively eradicated, and an ominous term was coined for the first time: "life unworthy of life."

In 1920 the concept of living beings not worthy of the life they embodied gained impetus with a tract published by two university professors, Karl Binding and Alfred Hoche. Permission for the Destruction of Life Unworthy of Life articulated key implications for people with disabilities. Binding and Hoche called for the killing of people with disabilities, whom they viewed as "incurable idiots" having no will or sense of living. Killing them, therefore, was hardly involuntary euthanasia, that is, the imposition of others' will upon them. This shifted the burden of human existence from simply being alive to requiring an explicit justification for living. For Binding and Hoche, therefore, the right to live was to be earned, not assumed. One earned the right to live by being a useful economic contributor to society. Chief among the individuals they saw as being useless were those who seemed to have little or no human feeling, or in their terms, "empty human husks" whose only societal function was the consuming of precious resources while contributing nothing to society in return. In Binding and Hoche's terms, they were "useless eaters" whose "ballast lives" could be tossed overboard to better balance the economic ship of state. In speaking of those with disabilities, and explicitly advocating involuntary euthanasia, Binding and Hoche wrote,

Their life is absolutely pointless, but they do not regard it as being
unbearable. They are a terrible, heavy burden upon their relatives and
society as a whole. Their death would not create even the smallest
gap--except perhaps in the feelings of their mothers or loyal nurses.
(Burleigh, 1994, p. 17)

Furthermore, Binding and Hoche drove home the economic argument by calculating the total cost expended in caring for such people. They concluded that this cost was "a massive capital in the form of foodstuffs, clothing and heating, which is being subtracted from the national product for entirely unproductive purposes" (Burleigh, 1994, p. 19).

Binding and Hoche's polemic was furiously debated across Germany. One strident critic of the Binding and Hoche position was Ewald Meltzer, the director of an asylum in Saxony, who held that many of his charges did indeed have the ability to enjoy life inasmuch as their disabilities would allow. In an attempt to support his belief, Meltzer surveyed the parents of his patients to ascertain their perceptions of disability and euthanasia. To Meltzer's astonishment, the survey results showed a widely held contradiction among the parents that although they had strong emotional ties to their children, they simultaneously expressed, with varying degrees of qualification, a "positive" attitude toward killing them. In fact, only a handful of respondents completely rejected all notions of euthanasia (Proctor, 1988). The results of this survey were a harbinger of future public and official perceptions and actions toward people with disabilities. Meltzer's survey was later used as a major rationale for the killing of thousands of people with disabilities under the National Socialists, whose long-held social perceptions of difference coupled with official state prejudice delineated a series of genocidal markers that doomed significant numbers of people with disabilities during the Nazi era.

Genocidal Markers of Disability

Scientific research of the late 19th century was overshadowed by Darwin's ideas of biological determinism, including its most radical form, eugenics, which had begun to establish genetic markers predictive of physiological characteristics. The fate of people with disabilities in Germany may be understood by examining a similar series of genocidal markers, with corresponding sequelae, which determined the real-world fate of "useless eaters."

Marker 1: Darwinism and the Biology of Determination

Nineteenth- and early-20th-century Germany, like the rest of the Western world, had been significantly influenced by two powerful scientific impressions. First, the prominence of the biological sciences had been established by the revolutionary ideas of Charles Darwin, who provided reasonable explanations for distinct differences among many observed natural phenomena. Darwin and his contemporaries focused on inequalities within all living species, including humans. Darwin's ideas of evolution emphasized the struggle for survival and the notion that only the strongest and most able of any species would survive as genetic progenitors of future generations, thereby safeguarding the health, and ultimately the endurance, of that species. In short order, these ideas were applied to humans in the form of Social Darwinism, which held that in humans, both biological and social traits were passed from one generation to the next.

Thus, as scientists busied themselves with measurement, classification, and definitions based on physical, biological, and social similarity and difference, they not only reinforced popular social prejudices but enshrined them as irrefutable scientific fact. By the early 20th century, scientists had amassed a great deal of pseudodata portending to show differences between individuals, genders, and ethnic groups by rank ordering any population trait from superior to inferior. For example, individuals were judged as superior based on their race (White, with northern Europeans deemed superior to southern Europeans and Slavic ethnic groups) or their wealth (wealth was superior to poverty). In addition, levels of socially appropriate behavior (law-abiding, self-regulating, restrained, and conformist) were judged superior to socially inappropriate behavior (criminality or antisocial behavior; Friedlander, 1995). These and other classifications soon precipitated both informal social changes and more formal legal measures. Darwin's ideas gained widespread acceptance in Germany, where they nudged the predisposed intelligentsia toward accepting social inequality as presumptive long before Hitler's National Socialist party swept to power in 1933.

Second, an offshoot of Darwinism, Social Darwinism, held that not only biological traits but also social characteristics and their resultant behaviors were genetically determined. Social Darwinism's ideas of difference, therefore, in the form of eugenics, appeared to have immediate and effective application for a number of societal problems, such as "hereditary" social traits (e.g., socially inappropriate or criminal behavior). Here the rationale was simple: All visible traits of human difference were genetically determined. Thus, just as eye and hair color were genetically determined, so were drunkenness, sexual promiscuity, and other socially inappropriate behaviors. A simple extension of these perceptions led to the idea that an effective way of controlling or eliminating these problems was by sterilization, incarceration, or death.

Having established the concept of social heritability and its consequences for individual inequality, similar rankings of desirability were soon applied to entire groups of people, including grouping people by class. That is, the more "inferior" (i.e., lower class) the person, the more likely they would be to engage in undesirable social behavior (e.g., sexual promiscuity) and often criminal behavior (e.g., prostitution). This logic was then used to extrapolate that because many individuals from impoverished backgrounds committed undesirable social and criminal acts, and far fewer from among the wealthy, the entire lower class was characterized by criminality. People with disabilities, many of whom displayed inappropriate behavior or abnormal physical appearance, were among the groups of people thus classified. Based on these perceptions of difference, the next logical step was to control and eventually eradicate undesirable biological and social differences through eugenics.

Marker 2: Eugenics

The term eugenics was coined by the naturalist and mathematician Francis Galton in 1881. Eugenics was described by its leading American proponent, Charles Davenport, as "the science of the improvement of the human race by better breeding" (Friedlander, 1995, p. 4). The eugenicists believed Mendelian laws governed the heredity of human physiological traits (Darwinism) and social traits (Social Darwinism). Genetics, therefore, could be manipulated to enhance social ends. This assumption encouraged research on the transmission of social traits and the classification of individuals, groups, and whole societies on a scale of human worth.

Predictably, the results of these efforts isolated individuals and groups of people who appeared to have less intelligence, higher levels of antisocial behavior, and, therefore, by definition, less human worth than those higher up on the ability and prosocial behavior scales. In turn, the emphasis on human worth by rank allowed the eugenicists to study different segments of the scale. More often than not, they chose to study the lower end, including study of individuals with lower intelligence and those they considered socially deviant. Eugenics captured the imagination of researchers in Europe, England, and the United States. In the United States, politicians purportedly promoting the public good were quick to recognize eugenics as a powerful tool for shaping public opinion against people with disabilities. Such awareness fueled laws in many states for the involuntary sterilization of people with disabilities, the most famous case perhaps being that of a Virginia woman with mental retardation, Carrie Buck, named in the 1927 landmark Buck v. Bell case (Winzer, 1993).

Prior to World War I, the German eugenicists concurred with their American and British colleagues regarding a scale of human worth, dividing the German population into those who were superior (hochwertig) and inferior (minderwertig). Thus, eugenics asserted that the "feebleminded" (a generic, inaccurate term covering everything from mental retardation to alcoholism) were almost always so because of inherited inferior characteristics. From these assumptions, they "saw the cause of the social problems of their times, such as alcoholism and prostitution, as inherited feeblemindedness, and viewed the manifestations of poverty, such as intermittent employment and chronic illness, as a hereditary degeneracy" (Friedlander, 1995, p. 6).

However, without the political heterogeneity that encouraged diverse views within the genetics movement in the United States and, to a lesser extent, in England, German eugenicists' views were much more radically homogeneous. Until Germany's defeat in World War I, the German eugenicists concentrated on "positive Eugenics," through the encouragement of higher birth rates among superior populations, which reflected the German eugenic concentration on class rather than race. However, a precursor of future troubles appeared in a eugenic faction that favored the concept of the Nordic racial ideal and despised its inferior counterpart, the anti-Nordic (Friedlander, 1995). It was this concept that eventually dominated German eugenic discourse and became enshrined in the Nazi idea of Aryan supremacy.

The two genocidal markers of Social Darwinism and eugenics were firmly in place in the professional and lay psyche when the National Socialists, under the leadership of Adolf Hitler, were elected in January 1933. Thereafter, German acceptance of humanitarian inequality mixed with Hitler's racist convictions to produce the political ideology of the "Thousand Year Reich," a major component of which was the elimination of those deemed inferior (Friedlander, 1995). Furthermore, these two markers became the bedrock of increasingly coercive official policy, eventually killing thousands of people with disabilities. These two genocidal markers were then enacted in the real world, first by involuntary sterilization.

Marker 3: Forced Prevention of Disability

Discussions of eugenic sterilization in Germany became more prominent in the early 1920s and were bolstered by contemporaneous debates about the worth of human life, although sterilization was illegal in Germany until Hitler became chancellor. One of the first official acts undertaken by the Nazis was the enactment of a sterilization law in 1933, less than 6 months after their election. Grandly titled the Law for the Prevention of Genetically Diseased Offspring, it decreed compulsory sterilization for persons characterized by a wide variety of disabilities. The law also established a mechanism for deciding who should be sterilized, which consisted of 220 regional Hereditary Health Courts, each made up of a judge and two physicians. People in or recently discharged from institutions were particularly vulnerable to this law for obvious reasons. Approximately 30% to 40% of those sterilized between 1934 and 1936 were patients in asylums across Germany (Burleigh, 1994). The sterilization law reached many categories of the "heriditarily sick," including persons with mental retardation (200,000), schizophrenia (80,000), Huntington's chorea (600), epilepsy (60,000), blindness (4,000), hereditary deafness (16,000), grave bodily malformation (20,000), hereditary alcoholism (10,000), and other specified groups (Lifton, 1986).

The law was repeatedly amended to close loopholes that might allow some persons with disabilities to escape sterilization. For example, an amendment was added to cover women with a "hereditary disease" who became pregnant prior to sterilization, or women who were impregnated by men with such "diseases." In such cases the law officially sanctioned abortion and simultaneous sterilization (Friedlander, 1995). The law also stipulated heavy penalties for physicians carrying out such actions on persons or unborn children legally judged to be healthy.

Also in 1933, the Nazis enacted the Law Against Dangerous Habitual Criminals, a law that further blurred the distinction between bona fide criminal behavior and inappropriate social behavior that characterized many people with disabilities. The law stipulated that these criminal asozialen (asocials) could be committed to state asylums, held in indeterminate protective custody, and, in the case of sex offenders, officially castrated (Friedlander, 1995).

These and other laws were the precursors of the Nuremberg Laws of 1935, which, while directed primarily at Jews, also regulated marriage among people with disabilities. For example, the Marriage Health Law prohibited marriage between two people if either party suffered from some form of mental disability, had a "hereditary disease" as previously defined by law, or suffered from a contagious disease, particularly tuberculosis or venereal disease.

To this point, while Nazi law had become increasingly segregationist and isolationist for people with disabilities, it had not yet sanctioned murder, even though it is clear that as early as 1935 Hitler voiced thoughts that he would use the cover of war to murder psychiatric patients in fulfillment of a long-held belief that he had articulated in Mein Kampf (Yahil, 1987). However, Hitler understood that state-sanctioned homicide would depend on other factors to severely curb public outrage until war became reality. The war, Hitler reasoned, would provide both a distraction and an excuse for officially killing those deemed undesirable. One such factor was the use of propaganda to convince the public of the desirability of some lives over others.

Marker 4: Disability Propagandized as Life Unworthy of Living

By 1938 the tide of public and official benevolence toward people with disabilities had begun to turn. The public mind now characterized people with disabilities as a separate, different, often criminalized group of less economic value than their counterparts without disabilities. German literature and art soon depicted lives unworthy of living in a host of propagandistic projects (Lifton, 1986; Michalczyk, 1994). For example, two 1935 silent documentaries produced largely for distribution among Nazi Party functionaries and sympathizers depicted persons with severe physical and intellectual disabilities in staged scenes to show them to their greatest disadvantage (Burleigh, 1994; Lifton, 1986). Other films were produced for wider audiences. A 1935 propaganda sound film, Das Erbe (The Inheritance), depicted, in a pseudoscientific format, the medical, social, and economic consequences of hereditary disabilities. Other films soon followed. The 1937 film Opfer der Vergangenheit (The Victim of the Past) went much further, comparing healthy, ideal German citizens with institutionalized people with severe disabilities and adding that Jewish mental patients were creations in violation of natural law. The film proposed the solution of compulsory sterilization.

Propaganda was not limited to film, however, but also appeared in German literature. An exemplar of this work is the novel Sendung und Gewissen (Mission and Conscience), which was turned into a very popular film, Ich Klage an! (I Accuse!). In the story, a beautiful young woman suffering from multiple sclerosis decides that her life is no longer worth living and requests a "merciful death" at the hand of her husband, a physician. In the film's death scene climax, he administers the fatal injection to his wife, who dies peacefully to the strains of soothing piano music played by a friend in the next room. At his trial, the doctor heroically refuses to allow his colleagues to invent an alibi for the murder and challenges the court by asking, "Would you, if you were a cripple, want to vegetate forever?" Predictably, the court acquits the physician because his actions were merciful, not murderous, a notion reinforced in the closing scenes, where the words of the Renaissance physician Paracelsus are recalled, that "medicine is love" (Proctor, 1988).

This type of propaganda, fueled by then current perceptions of disability and euthanasia, profoundly affected the German public. By the late 1930s, requests for mercy killing were being received by Nazi officials. For example, requests were received from a woman ill with terminal cancer and from a man who had been severely injured and blinded in a construction accident (Burleigh, 1997). The state was also receiving similar requests from parents of newborns and young infants with severe physical and intellectual disabilities (Lifton, 1986).

To this point, Nazi involvement with mercy killing, while implicit, appears to have been muted and uninitiated by the state. However, social perceptions of disability had been radically modified, and requests for mercy deaths were increasing and were generally viewed as more acceptable, whether conducted by individual citizens or the state. Essentially, disability was widely acknowledged to be a legitimate justification for murder.

See what we could do if only the issues wasn't cluttered up with emotion and religious mumbo-jumbo...
Posted by Orrin Judd at March 30, 2005 8:13 PM

Comments

This certainly takes the argument that it is over the top hysterics to invoke the slippery slope argument over abortion and Terri and blows it out of the water.

Great article, but the authors lean a little too heavily on the common exculpatory excuse modern science uses when discussing all the scientific opinion of that era. By using phrases such as "pseudo-data", "propaganda" and "reinforcing popular prejudice", they leave the impression that it was all really empirical nonsense and that self-correcting science has grown up and left all that dishonesty behind. But was it all nonsense from a scientific perspective? We all observe and believe in some influence of breeding--that intelligent, healthy, good-looking and talented parents are at least more likely to have children with those characteristics than stupid, ugly, sickly or disturbed ones. C'mon, if science says we are all genetic cousins of the animals, and the success and benefits of animal breeding are incontrovertible, how can any scientific mind seriously believe the science behind eugenics was all hogwash, however impolite it may be to say so at the dinner table?

Now we have a new and rapidly growing category of scientifically-determined "lives-not-worth-living". As the Schiavo case shows, most secularists are completely unable to step outside empiricism and say, loudly and proudly, that they don't care what science says, it's not a scientific issue. Instead, they wank on about cerebral cortexes and sensory responses, and engage in undergraduate-like philosophical debates on whether there is any "real" difference between a feeding tube and life-support. They are completely oblivious to the fact that they are just mimicking and building on what their ancestors did, with equally valid scientific questions, hypotheses and, sadly, conclusions. And like the professor who discovered to his horror that most of the families of the severely disabled were ambiguous about their survival, they don't want to see that this is more about fighting human nature than accommodating it. When you set out on a single-minded crusade to accommodate human nature, people die. That's why they always conclude for death, whatever the controversy and whichever logical path they take.

The article is great with it’s the information it gives and its scientific bias. I believe the matter of euthanasia is rather ethical than scientific. No scientist can define the border between "lives-not-worth-living" and those that are worth it.
I've come across the matter only once in my life, when after the cerebral thrombosis my grandmother experienced a number of physical and mental changes that seemed irreversible. But for 2 times I suddenly saw her "awaken" from this horrible state. I can't judge the case with confidence, but this did happen.